Influenza
Conditions
Keywords
influenza, flu
Brief summary
This is a study for patients with flu who also have a fever as well as other flu symptoms. Patients must have had symptoms for less than 48 hours in order to participate. Patients will have two out of three chances of getting an active study treatment and the other third will receive a placebo (dummy drug). Nobody will know who gets the active drug and who gets the inactive drug. All patients will get supplies to treat symptoms of flu. Patients will need to be seen 5 more times after they are enrolled in the study.
Detailed description
Peramivir is a neuraminidase inhibitor that was previously shown to be effective in the treatment of human experimental influenza using an oral formulation. Parenteral formulations of peramivir (for intramuscular and intravenous injection) entered clinical development at the time of this Phase 2 study. A series of Phase 1 studies in human volunteers was completed that provided safety and pharmacokinetic results that supported the initiation of this Phase 2 multinational, randomized, double-mask study that compared the antiviral efficacy and safety of peramivir administered intramuscularly versus placebo in adults with uncomplicated acute influenza. Because of the unique pharmacokinetic and pharmacodynamic properties of peramivir - a long terminal half life in plasma and an extended duration of binding to the neuraminidase enzyme - subjects were randomized in a 1:1:1 ratio to receive a single dose of one of three treatments: peramivir 150 mg, peramivir 300 mg, and placebo. Study drug was administered as one 2-mL intramuscular injection in each gluteal muscle (total of 4 mL, injected in divided doses). This multinational study was originally to be conducted at approximately 80 sites in the US and Canada. When enrollment during the North American influenza season of 2006-2007 did not achieve the target, the study was extended to sites in Australia, New Zealand, South Africa, and Hong Kong.
Interventions
DRUGPeramivir 150 mg
Single dose administered as bilateral 2-mL intramuscular injections in each gluteal muscle (one injection of peramivir 150 mg and one injection of placebo).
DRUGPeramivir 300 mg
Single dose administered as bilateral 2-mL intramuscular injections in each gluteal muscle (2 injections of peramivir 150 mg).
DRUGPlacebo
Single dose administered as bilateral 2-mL intramuscular injections in each gluteal muscle (2 injections of placebo).
Sponsors
BioCryst Pharmaceuticals
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years * Presence of fever at time of screening of ≥38.0 ºC (≥100.4 ºF) taken orally, or ≥38.5 ºC (≥101.2 ºF) taken rectally. However, this requirement is waived if the subject has a history of fever within the 24 hours prior to screening and has been administered antipyretic(s) in the 6 hours prior to screening. * Presence of at least one respiratory symptom (cough, sore throat, or nasal symptoms) of any severity (mild, moderate, or severe) * Presence of at least one constitutional symptom (headache, malaise, myalgia, sweats and/or chills, or fatigue) of any severity (mild, moderate, or severe) * Onset of illness no more than 48 hours before presentation. Note: Time of onset of illness is defined as either (1) the time when the temperature (either oral or rectal) was first measured as elevated (at least one ºC of elevation-oral temperature), OR (2) the time when the subject experienced the presence of at least one respiratory symptom AND the presence of at least one constitutional symptom. * Rapid Antigen Test (RAT) performed on an adequate specimen collected from an anterior nasal swab is positive. A negative initial RAT may be repeated within one hour of obtaining a negative result. A second negative RAT result will exclude the subject from evaluation for enrollment. * Females of childbearing potential must report one of the following: * Be surgically sterile * Have been sexually abstinent 4 weeks prior to date of screening evaluation and be willing to remain abstinent through 4 weeks after study drug administration * Use oral contraceptives or other form of hormonal birth control including hormonal vaginal rings or transdermal patches and have been using these for 3 months prior through 4 weeks after study drug administration * Use an intra-uterine device (IUD), or adequate barrier contraception (or double-barrier method such as condom or diaphragm with spermicidal gel or foam) as birth control 4 weeks prior to date of screening evaluation through 4 weeks after study drug administration.
Exclusion criteria
* Women who are breast-feeding * History of diagnosed chronic obstructive pulmonary disease or diagnosis of severe persistent asthma * History of chronic renal impairment requiring hemodialysis or known or suspected to have moderate or severe renal impairment (actual or estimated creatinine clearance \<50 mL/min) * History of congestive heart failure requiring daily pharmacotherapy with symptoms consistent with New York Heart Association Class II, III, or IV within the past 12 months * Immunocompromised status due to illness or previous organ transplant * Current use of systemic immunosuppressive medications (except inhaled corticosteroids) * Use of rimantadine, amantadine, zanamivir, or oseltamivir in the past 7 days * Immunized against influenza with live attenuated virus vaccine (FluMist®) in the previous 21 days * Clinical evidence of active bacterial infection at any body site requiring therapy with oral or systemic antibiotics * Clinically significant signs of acute respiratory distress * Clinically significant signs of acute cardiac disease * Screening ECG which suggests acute ischemia or presence of medically significant dysrhythmia * Presence of a chronic disease or illness(es) with either clinical or historical evidence of recent exacerbation of such disease(s) or illness(es) or lack of control of such disease(s) or illness(es) * History of hepatitis B, hepatitis C, or human immunodeficiency virus infection * History of alcohol abuse or drug addiction within 1 year prior to admission in the study * Participation in a study of any investigational drug within the last 30 days * Positive urine pregnancy test
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Alleviation of Symptoms (Kaplan-Meier Estimate) | Up to 14 days | Descriptive statistics for the primary efficacy variables were tabulated by treatment group. Alleviation of symptoms was determined by data recorded in the Subject Diary. Treatment differences were assessed using a Cox Regression model with effects for current smoking behavior, treatment, and geographic region. Subjects who did not experience alleviation of symptoms were censored at the date of their last assessment. A Bonferroni adjustment for the primary comparisons of each active dose with placebo was performed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time to Resumption of Ability to Perform Usual Activities | Up to 14 days | The time to resumption of a subject's self-assessed ability to perform his or her usual activities was estimated using the method of Kaplan-Meier. Differences between the treatment groups were assessed using the log rank statistic controlling for current smoking behavior. Subjects who were not able to resume performance of usual activities were censored at the time of the last assessment. |
| Change From Baseline to Day 2 in Influenza Virus Titer | Baseline and approximately 24 hours after treatment | The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment). |
| Time to Resolution of Fever | Up to 14 days | The time to resolution of fever (defined as the number of hours from initiation of study drug until temperature is less than 37.2 degrees C \[99.0 degrees F\] and no antipyretic medications had been taken in the previous 12 hours) was estimated using the method of Kaplan-Meier. Differences between the treatment groups were assessed using the log rank statistic controlling for current smoking behavior. Subjects who did not have resolution of fever were censored at the time of the last assessment. No adjustment for multiple comparisons was performed. |
| Change From Baseline to Day 5 in Influenza Virus Titer | Baseline and approximately 96 hours after treatment | The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment). |
| Change From Baseline to Day 9 in Influenza Virus Titer | Baseline and approximately 192 hours after treatment | The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment). |
| Change From Baseline to Day 3 in Influenza Virus Titer | Baseline and approximately 48 hours after treatment | The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment). |
Countries
Canada, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Single dose administered as bilateral 2-mL intramuscular injections in each gluteal muscle (2 injections of placebo). | 114 |
| Peramivir 150 mg Single dose administered as bilateral 2-mL intramuscular injections in each gluteal muscle (one injection of peramivir 150 mg and one injection of placebo). | 113 |
| Peramivir 300 mg Single dose administered as bilateral 2-mL intramuscular injections in each gluteal muscle (2 injections of peramivir 150 mg). | 115 |
| Total | 342 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 0 | 0 | 1 |
| Overall Study | Lost to Follow-up | 2 | 1 | 1 |
| Overall Study | Randomized in Error, Not Treated | 1 | 1 | 0 |
| Overall Study | Withdrawal by Subject | 0 | 0 | 1 |
Baseline characteristics
| Characteristic | Peramivir 150 mg | Placebo | Peramivir 300 mg | Total |
|---|---|---|---|---|
| Age, Continuous | 36.2 years STANDARD_DEVIATION 15.59 | 33.9 years STANDARD_DEVIATION 12.05 | 36.2 years STANDARD_DEVIATION 13.25 | 35.4 years STANDARD_DEVIATION 13.71 |
| Age, Customized 18 - 27 years old | 37 participants | 41 participants | 34 participants | 112 participants |
| Age, Customized 28 - 37 years old | 31 participants | 37 participants | 35 participants | 103 participants |
| Age, Customized 38 - 47 years old | 21 participants | 19 participants | 25 participants | 65 participants |
| Age, Customized 48 - 57 years old | 10 participants | 9 participants | 12 participants | 31 participants |
| Age, Customized ≥ 58 years old | 13 participants | 8 participants | 9 participants | 30 participants |
| Age, Customized Missing | 1 participants | 0 participants | 0 participants | 1 participants |
| Body Mass Index at Screening | 27.5 kg/m^2 STANDARD_DEVIATION 6.23 | 26.5 kg/m^2 STANDARD_DEVIATION 5.69 | 27.8 kg/m^2 STANDARD_DEVIATION 6.35 | 27.2 kg/m^2 STANDARD_DEVIATION 6.11 |
| Body Surface Area | 1.9 m^2 STANDARD_DEVIATION 0.25 | 1.9 m^2 STANDARD_DEVIATION 0.26 | 1.9 m^2 STANDARD_DEVIATION 0.28 | 1.9 m^2 STANDARD_DEVIATION 0.26 |
| Current Smoking Behavior at Randomization Nonsmoker | 91 participants | 88 participants | 90 participants | 269 participants |
| Current Smoking Behavior at Randomization Smoker | 22 participants | 26 participants | 25 participants | 73 participants |
| Estimated Time of Onset of Symptoms at Screening 0 - 12 hours ago | 4 participants | 1 participants | 4 participants | 9 participants |
| Estimated Time of Onset of Symptoms at Screening > 12 - 24 hours ago | 32 participants | 37 participants | 25 participants | 94 participants |
| Estimated Time of Onset of Symptoms at Screening > 24 - 36 hours ago | 43 participants | 45 participants | 46 participants | 134 participants |
| Estimated Time of Onset of Symptoms at Screening > 36 - 48 hours ago | 34 participants | 31 participants | 40 participants | 105 participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants | 6 Participants | 4 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 104 Participants | 108 Participants | 111 Participants | 323 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Influenza Infection Missing | 0 participants | 0 participants | 1 participants | 1 participants |
| Influenza Infection Negative | 9 participants | 5 participants | 9 participants | 23 participants |
| Influenza Infection Positive | 104 participants | 109 participants | 105 participants | 318 participants |
| Initial Composite Symptom Score | 14.3 units on a scale STANDARD_DEVIATION 3.22 | 14.3 units on a scale STANDARD_DEVIATION 3.7 | 14.1 units on a scale STANDARD_DEVIATION 3.92 | 14.2 units on a scale STANDARD_DEVIATION 3.62 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 4 Participants | 7 Participants | 7 Participants | 18 Participants |
| Race (NIH/OMB) Black or African American | 18 Participants | 21 Participants | 17 Participants | 56 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 8 Participants | 6 Participants | 4 Participants | 18 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 5 Participants | 3 Participants | 6 Participants | 14 Participants |
| Race (NIH/OMB) White | 78 Participants | 77 Participants | 81 Participants | 236 Participants |
| Sex: Female, Male Female | 67 Participants | 54 Participants | 62 Participants | 183 Participants |
| Sex: Female, Male Male | 46 Participants | 60 Participants | 53 Participants | 159 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 31 / 114 | 27 / 113 | 25 / 115 | 83 / 342 |
| serious Total, serious adverse events | 1 / 114 | 0 / 113 | 1 / 115 | 2 / 342 |
Outcome results
Primary
Time to Alleviation of Symptoms (Kaplan-Meier Estimate)
Descriptive statistics for the primary efficacy variables were tabulated by treatment group. Alleviation of symptoms was determined by data recorded in the Subject Diary. Treatment differences were assessed using a Cox Regression model with effects for current smoking behavior, treatment, and geographic region. Subjects who did not experience alleviation of symptoms were censored at the date of their last assessment. A Bonferroni adjustment for the primary comparisons of each active dose with placebo was performed.
Time frame: Up to 14 days
Population: The intent-to-treat infected (ITTI) population included all randomized subjects who received study drug and had proven influenza by culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Of the 318 subjects in the ITTI population, one subject had insufficient data to determine Time to Alleviation of Symptoms.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Time to Alleviation of Symptoms (Kaplan-Meier Estimate) | 136.2 Hours |
| Peramivir 150 mg | Time to Alleviation of Symptoms (Kaplan-Meier Estimate) | 114.1 Hours |
| Peramivir 300 mg | Time to Alleviation of Symptoms (Kaplan-Meier Estimate) | 117.4 Hours |
p-value: 0.377Regression, Cox
Secondary
Change From Baseline to Day 2 in Influenza Virus Titer
The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment).
Time frame: Baseline and approximately 24 hours after treatment
Population: The ITTI population included all subjects who were randomized, received study drug, and had proven influenza by any one of the following: culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Subjects were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Change From Baseline to Day 2 in Influenza Virus Titer | -1.50 log10(TCID50/mL) |
| Peramivir 150 mg | Change From Baseline to Day 2 in Influenza Virus Titer | -2.00 log10(TCID50/mL) |
| Peramivir 300 mg | Change From Baseline to Day 2 in Influenza Virus Titer | -2.25 log10(TCID50/mL) |
p-value: 0.002Wilcoxon (Mann-Whitney)
Secondary
Change From Baseline to Day 3 in Influenza Virus Titer
The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment).
Time frame: Baseline and approximately 48 hours after treatment
Population: The ITTI population included all subjects who were randomized, received study drug, and had proven influenza by any one of the following: culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Subjects were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Change From Baseline to Day 3 in Influenza Virus Titer | -2.75 log10(TCID50/mL) |
| Peramivir 150 mg | Change From Baseline to Day 3 in Influenza Virus Titer | -3.00 log10(TCID50/mL) |
| Peramivir 300 mg | Change From Baseline to Day 3 in Influenza Virus Titer | -3.25 log10(TCID50/mL) |
p-value: <0.001Wilcoxon (Mann-Whitney)
Secondary
Change From Baseline to Day 5 in Influenza Virus Titer
The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment).
Time frame: Baseline and approximately 96 hours after treatment
Population: The ITTI population included all subjects who were randomized, received study drug, and had proven influenza by any one of the following: culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Subjects were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Change From Baseline to Day 5 in Influenza Virus Titer | -3.75 log10(TCID50/mL) |
| Peramivir 150 mg | Change From Baseline to Day 5 in Influenza Virus Titer | -3.38 log10(TCID50/mL) |
| Peramivir 300 mg | Change From Baseline to Day 5 in Influenza Virus Titer | -3.63 log10(TCID50/mL) |
p-value: 0.409Wilcoxon (Mann-Whitney)
Secondary
Change From Baseline to Day 9 in Influenza Virus Titer
The change in viral titers was defined as the time-weighted change from baseline in log\_10 tissue culture infective dose\_50 (TCID\_50/mL) and was summarized for each treatment group. The differences between the treatment groups were evaluated using a Wilcoxon Rank Sum Test controlling for current smoking behavior. Specimens for virologic culture and determination of influenza virus TCID\_50/mL were obtained on Day 2 (approximately 24 hours after treatment), on Day 3 (approximately 48 hours after treatment), on Day 5 (approximately 96 hours after treatment), and on Day 9 (approximately 192 hours after treatment).
Time frame: Baseline and approximately 192 hours after treatment
Population: The ITTI population included all subjects who were randomized, received study drug, and had proven influenza by any one of the following: culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Subjects were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Change From Baseline to Day 9 in Influenza Virus Titer | -3.75 log10(TCID50/mL) |
| Peramivir 150 mg | Change From Baseline to Day 9 in Influenza Virus Titer | -3.75 log10(TCID50/mL) |
| Peramivir 300 mg | Change From Baseline to Day 9 in Influenza Virus Titer | -3.75 log10(TCID50/mL) |
p-value: 0.327Wilcoxon (Mann-Whitney)
Secondary
Time to Resolution of Fever
The time to resolution of fever (defined as the number of hours from initiation of study drug until temperature is less than 37.2 degrees C \[99.0 degrees F\] and no antipyretic medications had been taken in the previous 12 hours) was estimated using the method of Kaplan-Meier. Differences between the treatment groups were assessed using the log rank statistic controlling for current smoking behavior. Subjects who did not have resolution of fever were censored at the time of the last assessment. No adjustment for multiple comparisons was performed.
Time frame: Up to 14 days
Population: The ITTI population included all subjects who were randomized, received study drug, and had proven influenza by any one of the following: culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Subjects were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Time to Resolution of Fever | 58.1 Hours |
| Peramivir 150 mg | Time to Resolution of Fever | 43.6 Hours |
| Peramivir 300 mg | Time to Resolution of Fever | 42.9 Hours |
p-value: 0.007Log Rank
Secondary
Time to Resumption of Ability to Perform Usual Activities
The time to resumption of a subject's self-assessed ability to perform his or her usual activities was estimated using the method of Kaplan-Meier. Differences between the treatment groups were assessed using the log rank statistic controlling for current smoking behavior. Subjects who were not able to resume performance of usual activities were censored at the time of the last assessment.
Time frame: Up to 14 days
Population: The ITTI population included all subjects who were randomized, received study drug, and had proven influenza by any one of the following: culture, PCR, or paired serology showing ≥ 4-fold increase in antibody to influenza A or B. Subjects were analyzed according to the treatment to which they were randomized.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Time to Resumption of Ability to Perform Usual Activities | 10.1 Days |
| Peramivir 150 mg | Time to Resumption of Ability to Perform Usual Activities | 9.2 Days |
| Peramivir 300 mg | Time to Resumption of Ability to Perform Usual Activities | 8.3 Days |
p-value: 0.537Log Rank